When people talk about a wolf in sheep’s clothing, they generally mean something that appears benign on the surface hiding something sinister underneath. In the case of Trumpcare, the clothing — repealing and replacing the Affordable Care Act (ACA) — is no sheep. It itself is a frighteningly destructive wolf. But it is hiding an even more destructive wolf.
The clothing of repealing and replacing the ACA will unquestionably put affordable health care out of the reach of millions of Americans. If Trump and his Congressional cronies succeed in destroying the ACA, they will cause 32 million Americans to lose their health care. For people who still have health insurance coverage, Trumpcare will make it much less adequate and much more expensive.
If the GOP succeeds in repealing the ACA, it will be a giant step backward, returning us to the world of a decade ago. But that clothing is hiding the worst part of Trumpcare.
The hidden part of Trumpcare would return us to the world of over a half century ago, before Medicaid, when almost all seniors and low-income Americans found themselves constantly on the edge, one illness away from bankruptcy — or worse, unable to get care at all.
Much has been written about how much will be cut from Medicaid spending. What has gone largely unsaid, though, is that the latest version of Trumpcare repeals Medicaid and replaces it with cash to states to do with what they want, as long as the money is spent on health care in some way. The destruction of Medicaid is the larger wolf, lurking beneath the repeal-of-ACA clothing.
Medicaid insures 69 million Americans and represents three percent of the nation’s gross domestic product. Not surprisingly, the National Association of Medicaid Directors (NAMD), which represents the front-line Medicaid administrators from red states and blue states alike, has come out against this latest version of Trumpcare. Recognizing the wolf beneath the clothing, it makes the obvious, commonsense point, “Any effort of this magnitude needs thorough discussion, examination and analysis, and should not be rushed through without proper deliberation.”
Under Medicaid, all individuals who meet the criteria are guaranteed that their doctor’s visits, hospital stays, nursing home costs, and other insurance-covered expenses will be paid as a matter of right. The more people in a state who qualify for Medicaid and the larger their costs, the more the federal government provides. In contrast, under Trumpcare, every state would simply be given a specific, capped amount of money to spend as it sees fit. If the amount is insufficient or the state chooses to spend the money differently, too bad for those Americans left out in the cold.
Prior to the passage of Medicaid and Medicare, seniors, those with disabilities, children from low income families, and others who either could not afford or were excluded from private insurance had no choice but to rely on the charity of doctors, public hospitals, and clinics. And they often simply went without. Though these groups have greater medical needs, on average, than higher-income working Americans, they received fewer medical services. Immediately after the enactment of Medicaid and Medicare, Americans’ overall health improved substantially.
The passage of Medicaid and Medicare was extremely hard fought. Policymakers who believe that universal, high quality health care is a right, not a privilege, tried to enact government sponsored health care at the start of the 20th century. President Franklin Roosevelt might have succeeded, but World War II intervened. President Harry Truman made it a top priority, but could not overcome Republican resistance. With that history of coming up short, policymakers decided to try an incremental approach.
Even then, the election of a popular, determined President John F. Kennedy was not enough. Indeed, it took the assassination of that popular president, a new president who was a master at getting Congress to bend to his will, the recognition that the legislation would be a testament, fulfilling Kennedy’s legacy, and an engaged electorate to get Medicaid and Medicare enacted. It would be catastrophic if Medicaid, which so many fought so hard to enact, got undone under the cloak of repealing the ACA.
It is not surprising that Republican politicians are seeking to hide their longstanding goal of ending Medicaid. Given how popular and successful Medicare and Medicaid have been, conservatives generally disguise their hatred of these programs under the claim that they are simply trying to “save” them. In the Trumpcare debate, Republican politicians muddy the waters even more by talking simply about the ACA’s Medicaid expansion, not their hatred of the underlying Medicaid program.
But the failure to talk about ending Medicaid does not change the truth. Trumpcare goes at the heart of Medicaid. In short, Trumpcare is a wolf in wolf’s clothing.
Given how devastating Trumpcare is to Americans’ health, it is no surprise that dozens of groups fighting deadly diseases — including the American Cancer Society, American Heart Association, the Alzheimer’s Association, American Diabetes Association, Easter Seals, and the March of Dimes — oppose Trumpcare.
The same reason explains why all of those who work in the health care sector — including the American Medical Association, the American Academy of Pediatrics, the American Nurses Association, the American Hospital Association, Blue Cross Blue Shield Association, and America’s Health Insurance Plans — oppose Trumpcare.
The AARP and other groups representing seniors, working families, women, people with disabilities, and virtually all other demographics are against Trumpcare. It is hard to have approval ratings in the single digits or teens, but every version of Trumpcare has managed to be that unpopular.
And make no mistake about it: If the Republicans are successful at destroying Medicaid, Medicare is not far behind. And then, Social Security.
These three programs, all titles of the Social Security Act, show government at its best. Our government runs these extremely popular and successful programs more efficiently and effectively than the private sector runs any of its alternatives. And because insurance works best when coverage is broadest, no state can run these programs as efficiently or as well on their own.
But the facts don’t matter to Republican politicians. The Republican elite — with its seemingly religious belief that the private sector is always the best and the federal government is always the problem — hates Social Security, Medicare, and Medicaid, and wants to see all three ended.
Revealingly, just two days after the 2016 election, Speaker Paul Ryan attacked Medicare and Medicaid with a series of blatant falsehoods. In a post-election interview, Ryan fraudulently claimed, “You have to deal with [Medicare and Medicaid] if you are going to repeal and replace Obamacare.” He falsely stated that, “because of Obamacare, Medicare is going broke.” The reality is that Medicare is not “going broke.” Indeed, the ACA strengthened Medicare’s finances. And Medicaid can unquestionably be left out of Republican efforts to undo the individual mandate, the exchanges, the essential services requirements, and the other parts of the ACA about which Republican politicians complain.
Don’t be fooled. Despite their rhetoric, the Republican elites have their knives out not just for Medicaid. Not just for Medicare. But for our Social Security system, too. If Medicaid falls, those who want to end all three programs will be emboldened.
Our country is at a crossroads. While Republicans are intent on destroying Medicaid, Medicare and Social Security, Democrats are advocating that we expand Medicare and Social Security, while protecting Medicaid.
So which way do we go? Do we go forward to expanding Medicare and protecting Medicaid or backwards toward ending Medicaid, and privatizing Medicare, as Speaker Paul Ryan, HHS Secretary Tom Price, and their fellow ideologues have proposed? Do we expand Social Security or do we let the Republicans destroy it, once they have destroyed Medicaid and Medicare?
It is imperative that each of us do what we can now to defeat Trumpcare. Call your representatives, senators, and the White House. Write letters to the editor. Sign petitions. Go to town hall meetings. March. Do whatever you have the time, energy, and resources to do.
Whether Trumpcare, along with its destruction of Medicaid, becomes law or is narrowly defeated, each of us must make our voices heard in 2018. The politicians who are turning their backs on those they are elected to serve by voting for this monstrosity in wolf’s clothing should be voted out of office and replaced with those committed to strengthening, not weakening, our economic and health security.